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Sensitization patterns to common allergens in Korean children younger than 6 years of age presenting with typical symptoms or signs of allergic diseases: a single center study.

Jung Won YOON ; Sang Min LEE ; Joon Hwan KIM ; Na Yeon KIM ; Ji Hyeon BAEK ; Hey Sung BAEK ; Hye Mi JEE ; Hyeung Yoon KIM ; Sun Hee CHOI ; Ki Eun KIM ; Hye Yung YUM ; Man Yong HAN ; Jintack KIM ; Youn Ho SHIN

Allergy, Asthma & Respiratory Disease.2014;2(4):272-276. doi:10.4168/aard.2014.2.4.272

PURPOSE: Population studies have reported that sensitization to inhalant allergens is rare in young children; however, most subjects in those studies had little or no symptoms or signs highly suggestive of allergic diseases. The aim of the present study was to assess the prevalence of sensitization to inhalant allergens in young children with symptoms and/or signs of allergic disease. METHODS: We analyzed the results of all specific IgE tests performed at our hospital laboratory in children younger than 6 years presenting with symptoms and/or signs highly suggestive of allergic diseases between 2008 and 2013. Specific IgE tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae, Alternaria alternata, German cockroach, cat dander, egg white or egg yolk, milk, peanut, and soybean were performed on 295 children; a specific IgE concentration > or =0.35 or > or =0.2 IU/mL was considered positive. We also compared allergen sensitization rates using the two cutoff values. RESULTS: One hundred eighty-one children (61.4%) were positive to at least 1 allergen tested and 53 children (18.9%) were positive to at least 1 inhalant allergen when a specific IgE concentration > or =0.35 IU/mL was considered positive. The children were more likely to have asthma or allergic rhinitis when they were sensitized to any inhalant allergen, particularly house dust mites. The prevalence of sensitization to inhalant allergens increased with age (P<0.001). There was no significant difference in the prevalence of polysensitization among different age groups, but sensitization to both inhalant and food allergens significantly increased with age. CONCLUSION: Our results suggest that specific IgE tests to common inhalant allergens, particularly the house dust mites, may be considered when performing blood screening tests for young children presenting with symptoms and/or signs of allergic diseases.
Allergens* ; Alternaria ; Animals ; Asthma ; Blattellidae ; Cats ; Child* ; Dander ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Egg White ; Egg Yolk ; Humans ; Immunoglobulin E ; Laboratories, Hospital ; Mass Screening ; Milk ; Prevalence ; Pyroglyphidae ; Rhinitis ; Soybeans

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Outcome of acute respiratory distress syndrome in children: a single center study.

Sung Shil KANG ; Ra Mee PAE ; Eu Kyoung LEE ; Kyung Won BANG ; Hwan Soo KIM ; Yoon Hong CHUN ; Jong Seo YOON ; Hyun Hee KIM ; Jin Tack KIM ; Joon Sung LEE

Allergy, Asthma & Respiratory Disease.2014;2(4):266-271. doi:10.4168/aard.2014.2.4.266

PURPOSE: This study aimed to determine the incidence, etiology, prognostic factors, and outcome of acute respiratory distress syndrome (ARDS) in children and to provide epidemiological data of children with ARDS treated at the pediatric intensive care unit (PICU) of a single center in Korea. METHODS: We conducted a retrospective medical chart review of 19 children diagnosed with ARDS at the PICU of The Catholic University of Korea, Seoul St. Mary's Hospital, between March 2009 and February 2012. RESULTS: Of the 334 PICU patients, 19 (5.6%) satisfied the American-European Consensus Conference definition of ARDS. Thirteen patients with ARDS died (mortality rate, 68.4%). Pneumonia was the most common cause of ARDS and observed in 10 patients (52.6%). There were significant differences between survivors and nonsurvivors in the PaO2/FiO2 ratio and the number of organ failure. The mortality rate was significantly higher in patients with a baseline PaO2/FiO2 ratio < or =100 mmHg than in those with a baseline PaO2/FiO2 ratio>100 mmHg (84.6% vs. 33.3%, P=0.046). We observed that a higher number of organ failure during the PICU stay, resulted in a higher mortality rate (P=0.037). Multiple logistic regression analysis showed that the PaO2/FiO2 ratio (adjusted odds ratio, 0.958) was independently associated with the increased risk of death after controlling for the number of organ failure. CONCLUSION: The mortality rate of ARDS in children was 68.4% in this study, a higher rate than those reported in other national and international studies. The PaO2/FiO2 ratio at the time of ARDS onset was a helpful prognostic factor for predicting the mortality rate of children with ARDS.
Child* ; Consensus ; Humans ; Incidence ; Intensive Care Units ; Korea ; Logistic Models ; Mortality ; Odds Ratio ; Pneumonia ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Seoul ; Survivors

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The effect of heat treatment or hydrolysis on cow's milk protein distributions and antigenicities.

Hee Seon LEE ; Mi Na KIM ; Jung Yeon HONG ; Won Il HEO ; Kyung Won KIM ; Myung Hyun SOHN ; Kyu Earn KIM ; Kyung Eun LEE ; Jung Won PARK

Allergy, Asthma & Respiratory Disease.2014;2(4):259-265. doi:10.4168/aard.2014.2.4.259

PURPOSE: Cow's milk protein is one of the most common and strongest food allergen. We investigated the effects of heat treatment on the distribution and antigenicities of major allergens from cow's milk. We also compared the protein distribution and antigenicities among cow's milk formula and its substitutes. METHODS: We heated alpha-casen, beta-lactoglobulin (BLG), alpha-lactalbumin (ALA), and crude extract of cow's milk in 100degrees C boiling water for 1 hour. We prepared crude extracts from cow's milk formula, partially hydrolyzed milk formula (pHF) and extensively hydrolyzed milk formula (eHF). The protein compositions of all the samples were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The antigenicities were determined by IgE immunoblotting with pooled serum collected from 11 patients with milk allergy. RESULTS: After heating, no significant alteration was found in casein, and the aggregates of ALA and BLG were detected with molecular weights of about 30 and 45 kDa, respectively. The antigenicities of newly detected aggregates were increased. The new aggregates of BLG with increased antigenicities were also found in heated milk total protein. Major milk allergens were not found in pHF, and residual components with a molecular weight below 10 KDa did not show IgE-binding activity. We failed to observe the residual components and antigenicities of eHF. CONCLUSION: Changes in protein distribution and antigenicity of milk total protein induced by heat treatment may not be significantly different from those of each major allergen. The residual components of pHF could have little IgE-binding capacity, and there may be few or no antigenic components in eHF.
Allergens ; Caseins ; Complex Mixtures ; Electrophoresis ; Heating ; Hot Temperature* ; Humans ; Hydrolysis* ; Immunoblotting ; Immunoglobulin E ; Lactalbumin ; Lactoglobulins ; Milk ; Milk Hypersensitivity ; Milk Proteins* ; Molecular Weight ; Sodium ; Water

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Clinical characteristics of primary spontaneous pneumothorax in adolescents: factors for recurrence.

Seung Joon LEE ; Min A CHA ; Yeol Ryoon WOO ; Eun Byul KWON ; Yeon Hwa AHN

Allergy, Asthma & Respiratory Disease.2014;2(4):251-258. doi:10.4168/aard.2014.2.4.251

PURPOSE: The aim of this study was to investigate the clinical characteristics of primary spontaneous pneumothorax (PSP) in adolescents and identify risk factors for the recurrence of PSP. METHODS: A total of 292 patients diagnosed with PSP from January 1998 to December 2011 were retrospectively studied. Clinical data on demographics, diagnostic imaging, therapies, and risk factors of recurrence were collected and analyzed. RESULTS: The sex ratio of 292 patients was 19.8:1 (male:female), and the average age of the patients was 17.0 years. The average body mass index of the patients was 18.8 kg/m2. The most common presenting symptom was chest pain. There was no seasonal variation in the incidence of PSP. Thirty patients (10.2%) had a history of smoking. The most common location of PSP was the left side. Out of 249 patients, 169 (67.9%) had cysts (blebs/bullae). Fifty-four patients (18.5%) received oxygen therapy, 3 patients (1%) needle aspiration, 119 patients (40.8%) closed tube drainage, and 116 patients (39.7%) surgery. The recurrence rate was 38.6%. Smoking was associated with the size of pneumothorax (P=0.002). Also, the size of pneumothorax and surgery was associated with recurrence (P=0.040 and P=0.004). However, previously reported risk factors for recurrence were not identified in our patients. CONCLUSION: Pediatric PSP occurred mainly in males in late adolescence with normal body mass index. No significant risk factors were related to recurrence of PSP in our study.
Adolescent* ; Body Mass Index ; Chest Pain ; Demography ; Diagnostic Imaging ; Drainage ; Humans ; Incidence ; Male ; Needles ; Oxygen ; Pneumothorax* ; Recurrence* ; Retrospective Studies ; Risk Factors ; Seasons ; Sex Ratio ; Smoke ; Smoking

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Association of body mass index with asthma, allergy rhinitis, and atopic dermatitis among adolescents in Incheon, South Korea.

Heejo KOO ; Sang Min LEE ; Sang Pyo LEE ; Euna HAN

Allergy, Asthma & Respiratory Disease.2014;2(4):243-250. doi:10.4168/aard.2014.2.4.243

PURPOSE: The current study investigated the association of body mass index with asthma and allergic diseases among adolescents in Incheon, South Korea. METHODS: The study sample included 2,140 teenagers living in Incheon. The standard questionnaires of the International Study of Asthma and Allergies in Childhood study were used to survey the prevalence of asthma, allergic rhinitis, and atopic dermatitis. In addition, family history of allergic diseases, height, and weight were collected via self-report. RESULTS: The average body mass index was higher in male adolescents with asthma (21.38 kg/m2) than in those without (20.19 kg/m2). Body mass index of male adolescents was associated asthma and atopic dermatitis (odds ratio [OR], 1.074; 95% confidence interval [CI], 1.008-1.143; P=0.026 for asthma and OR, 1.072; 95% CI, 0.998-1.150; P=0.056 for atopic dermatitis) after adjustment for family history of allergic diseases, age, and school as covariates. CONCLUSION: Asthma, allergic rhinitis, and atopic dermatitis are of highly prevalent in adolescents living in Incheon. Obesity may be associated with asthma in male adolescents.
Adolescent* ; Asthma* ; Body Mass Index* ; Dermatitis, Atopic* ; Humans ; Hypersensitivity* ; Incheon ; Korea ; Obesity ; Prevalence ; Rhinitis* ; Surveys and Questionnaires

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Chronic urticaria in children.

Jinho YU

Allergy, Asthma & Respiratory Disease.2014;2(4):236-242. doi:10.4168/aard.2014.2.4.236

Although it is difficult to find a cause of chronic urticaria in children, previous studies have been identified some triggers, such as autoimmunity, physical stimuli, food and its additives, and infection. History taking and physical examination remain the best tool for identifying an underlying cause of urticaria. First investigations include a complete blood count with differential, erythrocyte sedimentation rate, and C-reactive protein in children with chronic urticaria. If physical stimuli are suspected as triggers of chronic urticaria, appropriate provocation tests can be performed. Although the frequency of autoimmune urticaria was relatively high compared to the other causes in children with chronic urticaria, it is not easy to apply routine use of autologous serum skin tests to clinical practice. Additional extensive laboratory investigations are not required in the majority of cases. Second-generation H1-antihistamines are the mainstay of treatment from current guidelines in children with chronic urticaria, and dosage can be increased if the standard dose is not effective. Data on chronic urticaria in children are scarce, and causes have been considered to be similar to those in adults. Therefore, diagnostic approaches and treatment principles of chronic urticaria in children have been derived from extrapolating data in adults. In the future, comparative studies for the causes of chronic urticaria between children and adults, and therapeutic modalities for refractory cases will be needed.
Adult ; Autoimmunity ; Blood Cell Count ; Blood Sedimentation ; C-Reactive Protein ; Child* ; Humans ; Physical Examination ; Skin Tests ; Urticaria*

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Oral immunotherapy for the treatment of immediate type food allergy.

Sooyoung LEE

Allergy, Asthma & Respiratory Disease.2014;2(4):229-235. doi:10.4168/aard.2014.2.4.229

Food allergies continue to increase exponentially and therapies that can modify the natural course of disease is a recent top priority of the research. IgE-mediated food allergy represents both a promising and an intriguing disease of application for allergen specific immunotherapy. In particular, oral immunotherapy (OIT) may offer a novel effective therapeutic modality for persistent and severe forms of food allergies. In such patients, avoidance of the causative foods only may be insufficient because of the risk of unplanned exposure to causative foods. In patients with cow's milk, hen's egg, and peanut allergies, several recently published studies, including meta-analysis, confirmed the overall benefit of OIT. However, the definitive evidence of efficacy and safety with long-term therapeutic or disease-modifying effects is limited. In current protocols, entry indications, and initial-escalating-maintenance doses, the form of antigens, durations, and follow-up periods await to be standardized. Most of the clinical trials of OIT demonstrate effective desensitization, but the ability for inducing long-term tolerance remains to be improved, and the ratio of risks versus benefits of OIT should be considered in detail. The ultimate goal is extending OIT to primary care practice, but at this time, OIT remains within the purview of allergy specialists in terms of associated risk-benefit ratios, related safety, and long-term tolerance induction.
Food Hypersensitivity* ; Humans ; Hypersensitivity ; Immunotherapy* ; Milk ; Ovum ; Peanut Hypersensitivity ; Primary Health Care ; Specialization

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The antigenicities of heat treated and hydrolyzed cow's milk protein.

So Yeon LEE

Allergy, Asthma & Respiratory Disease.2014;2(4):227-228. doi:10.4168/aard.2014.2.4.227

No abstract available.
Hot Temperature* ; Milk Proteins*

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Dapsone-induced drug reaction with eosinophilia and systemic symptoms syndrome, misdiagnosed as lymphoma.

Bomi SHIN ; So Young PARK ; Sun Young YOON ; Eun Hye SHIN ; Young Joo YANG ; Hyung Jin CHO ; Il Young JANG ; Dong Uk KANG ; Tae Bum KIM ; You Sook CHO ; Hee Bom MOON ; Hyouk Soo KWON

Allergy, Asthma & Respiratory Disease.2013;1(4):400-404. doi:10.4168/aard.2013.1.4.400

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction with systemic manifestations. Dapsone is known to be useful for treatment of leprosy and various dermatologic conditions. We report a patient with prurigo pigmentosa who developed DRESS syndrome after dapsone treatment. She presented with lymphadenopathy, fever, eosinophilia, skin rash, and elevated liver enzymes. Initial lymph node and skin biopsy was suggestive of peripheral T-cell lymphoma. Initially, she was treated with chemotherapy. A week later after complete remission of skin symptoms, new skin lesions recurred. TCR-gene rearrangement was examined to show negative results and she was diagnosed as dapsone induced DRESS syndrome. This case emphasizes the importance of differential diagnosis of lymphoma and DRESS syndrome.
Biopsy ; Dapsone ; Diagnosis, Differential ; Drug Hypersensitivity ; Drug Hypersensitivity Syndrome* ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Eosinophilia ; Exanthema ; Fever ; Humans ; Leprosy ; Liver ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma ; Lymphoma, T-Cell, Peripheral ; Prurigo ; Pseudolymphoma ; Skin

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Successful desensitization for antitubercular drugs.

Ae Ra LEE ; Soo Jung KIM ; Junghyun KIM ; Ju Hee PARK ; Jung Kyu LEE ; Ju Young KIM ; Suh Young LEE ; Hye Ryun KANG

Allergy, Asthma & Respiratory Disease.2013;1(4):395-399. doi:10.4168/aard.2013.1.4.395

Tuberculosis is an infectious disease that can be treated using a combination of antitubercular drugs. First-line antitubercular agents such as isoniazid and rifampin are considered pivotal to successful treatment. However, they are also known to have relatively high rates of adverse events including hypersensitivity reactions. Discontinuing the first-line agents in the event of hypersensitivity may significantly compromise the cure rate of tuberculosis. Drug desensitization can be an effective method allowing continued use of the first-line agents and achieving successful cure of tuberculosis. A 70-year-old man was diagnosed with culture proven pulmonary tuberculosis and treated with first-line antitubercular agents (isoniazid, 300 mg; rifampin, 600 mg; pyrazinamide, 1,500 mg; and ethambutol, 800 mg). After 2 weeks of treatment, generalized erythematous papular rash and fever developed, for which all drugs were discontinued. Since he had hypersensitivity to all 4 first-line antitubercular agents, we tried desensitization for all 4 drugs one by one to resume antituberculosis treatment. After successful desensitization of all 4 first-line antituberculosis drugs, 6 months-antitubercular therapy was completed without any complications. We report here a case of multiple desensitization in a pulmonary tuberculosis patient having hypersensitivity to all of the 4 first-line antitubercular drugs, successfully completing 6-month antitubercular therapy without any complications.
Aged ; Antitubercular Agents* ; Communicable Diseases ; Drug Hypersensitivity ; Ethambutol ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Isoniazid ; Pyrazinamide ; Rifampin ; Tuberculosis ; Tuberculosis, Pulmonary

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